Letter from the editors

Article Outline

• Copyright

The final issue of this three-part positron emission tomography (PET) seminar begins with a review of the Johns Hopkins experience with melanoma. The value of PET in this disease was recognized very early and was one of the first to receive Centers for Medicare and Medicaid Services (CMS) approval for reimbursement. The initial approval came in July 1999 for the evaluation of recurrence prior to surgery. In July 2001 this was extended to diagnosis, staging, and treatment, but regional nodes are still not covered. Melanoma represents one of the most glucose-avid neoplasms that we are called upon to study.

Two areas that are not yet approved by CMS, but appear to benefit from study with PET, are the female reproductive tract and the skeletal-muscular system. Both are reviewed by physicians working at the University of Southern California. The results are quite promising and further demonstration of efficacy should qualify them for reimbursement.

Memorial Sloan-Kettering Cancer Center has accumulated considerable experience in utilizing PET in the genitourinary tract, particularly prostate cancer. These lesions have not been regarded as one of the strong indications of PET imaging. However, as Drs. Schöder and Larson point out, there are several specific areas in which it may be quite useful in defining both the location and extent of disease.

Nuclear medicine’s role in planning radiotherapy treatment portals and monitoring the effect of the therapy have long been recognized. However, PET technology and, in particular, PET/CT fusion imaging, have greatly enhanced this role. As discussed by Dr. Bujenovic, even more precise localization of various tumors is now achievable.

Finally, we are expanding our knowledge of PET’s role in benign disease. In Part II we commented on PET and the brain. At that time the brain approval was very limited. Since then, Alzheimer’s disease has finally achieved its long sought approval by CMS. Cardiac studies assessing perfusion with Rubidium and viability with FDG also have become routine procedures. These cardiac applications will be discussed in the next issue of Seminars in Nuclear Medicine (January 2005) that will be devoted to “Advances in Nuclear Cardiology.”

The next frontier may well be infection imaging. Dr. Abass Alavi and his team at the University of Pennsylvania have been at the cutting edge of these investigations. His group describes PET’s potential role in infection and other benign abnormalities. The Editors would like this opportunity to congratulate Dr. Alavi for the well deserved honor he received recently as the recipient of the 2002 Hevesy Nuclear Pioneer Award from the Society of Nuclear Medicine.

We believe that these three PET issues have provided an excellent state-of-the-art report for this exciting technology. Although it has taken more than a half-century for PET to achieve its recognition from the general medical community, the future appears boundless.